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1.  Found in translation: decoding local understandings of genetics and heredity in a Yup'ik Eskimo community 
The Center for Alaska Native Health Research is a community-based participatory research center that conducts studies involving genetic research with Yup'ik Eskimo community members in Southwest Alaska, where Yup'ik remains the first language for most residents. Cultural equivalents are needed to communicate results of these studies among all partners and members of the participating communities, since many scientific terms have no direct translation in Yup'ik. To inform that effort, we examined local understandings of genetics and heredity in one community. Here, we report results from back-translated Yup'ik interviews, and identify working genetic concepts shared by participants from interviews and focus groups. We suggest issues involved in, and some potential steps toward, developing a concise, scientifically accurate and culturally relevant term for “genetics” and other health concepts.
PMCID: PMC3711414  PMID: 23832886
back-translation; Center for Alaska Native Health Research; community-based participatory research; genetic concepts; public understanding of science; science communication; Yup'ik Eskimo
2.  Independent Review Of Social And Population Variation In Mental Health Could Improve Diagnosis In DSM Revisions 
Health affairs (Project Hope)  2013;32(5):10.1377/hlthaff.2011.0596.
At stake in the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are billions of dollars in insurance payments and government resources, as well as the diagnoses and treatment of millions of patients. We argue that the most recent revision process has missed social determinants of mental health disorders and their diagnosis: environmental factors triggering biological responses that manifest themselves in behavior; differing cultural perceptions about what is normal and what is abnormal behavior; and institutional pressures related to such matters as insurance reimbursements, disability benefits, and pharmaceutical marketing. In addition, the experts charged with revising the DSM lack a systematic way to take population-level variations in diagnoses into account. To address these problems, we propose the creation of an independent research review body that would monitor variations in diagnostic patterns, inform future DSM revisions, identify needed changes in mental health policy and practice, and recommend new avenues of research. Drawing on the best available knowledge, the review body would make possible more precise and equitable psychiatric diagnoses and interventions.
PMCID: PMC3837624  PMID: 23614899
A reduction in the maximal force output of muscles following pre-performance stretching has been reported. Several studies have suggested that localized vibration may enhance or replace stretching for gaining flexibility. It is important to know if localized vibration may also compromise muscle output. The purpose of this investigation was to determine the immediate effects of localized hamstring vibration on hamstrings (HAM) and quadriceps (QUAD) performance.
Thirty asymptomatic participants, 19 female and 11 male, mean age 25.4 years (±SD 2.7) received either five minutes of localized vibration to the right hamstrings at 30 Hz and 6 mm amplitude, or sham. One week later, each participant received the alternate treatment. Following treatments, right (R) and left (L) isometric HAM and QUAD strength was measured twice by handheld dynamometer and maximal horizontal hop distance of each lower extremity was measured by single leg hop test (SLH). Treatment outcomes were compared using paired t-tests. Treatment order effect was measured by independent T-test. Pre-study intrarater reliability for dynamometry was established using ICC(3,2).
Mean (±SD) values for strength following vibration were 58.7 kg (15.7), 60.4 kg (14.0), 45.5 kg (14.2), 45.8 kg (13.2) for R QUAD, L QUAD, R HAM, L HAM respectively. SLH mean values were R SLH 153.8 cm (35 cm) and L SLH 155.4 cm (36 cm). There were no significant differences in means between vibration and sham treatment for any outcomes on either leg (p-values ranged .412-.971); p<.001 for all comparisons. Order had no significant effect (p-values .370–1.0). Intrarater ICCs were .888, .762, .884, .960 for R HAM, L HAM, R QUAD, L QUAD.
Unilateral application of localized vibration to the hamstrings at a duration previously reported to increase flexibility did not diminish the isometric performance of the hamstrings or quadriceps of either leg.
Level of Evidence:
PMCID: PMC3414070  PMID: 22893858
hamstring; muscle performance; vibration
4.  “Excessive Thinking” as Explanatory Model for Schizophrenia: Impacts on Stigma and “Moral” Status in Mainland China 
Schizophrenia Bulletin  2009;36(4):836-845.
Although psychiatric stigma in China is particularly pervasive and damaging, rates of high expressed emotion (“EE” or family members' emotional attitudes that predict relapse) are generally lower than rates found in Western countries. In light of this seemingly incongruous juxtaposition and because Chinese comprise approximately one-fifth of the world's mentally ill, we examine how one of the most widely held causal beliefs of schizophrenia—excessive thinking (xiang tai duo)—may powerfully shape how those exhibiting psychotic symptoms pass from “normal” status to stigmatized “other.” Using a framework by which stigma threatens an actor's capacity to participate in core everyday engagements, we examine how expressions of excessive thinking intersect with psychotic symptoms and how this idiom reduces stigma by preserving essential moral standing. Four focus groups with family members (n = 34 total) of schizophrenia outpatients, who had participated in psychoeducation, were conducted in Beijing. Open coding was conducted by 2 bilingual coders achieving high interrater agreement. Common expressions of excessive thinking—taking things too hard that is perceived as a causal factor and unwarranted suspicion that is used to benignly interpret paranoid symptoms encapsulated disruptive behaviors that closely overlapped with psychotic symptoms. Because excessive thinking is understood to occur universally, this idiom encourages socially accommodating behavior that signifies acceptance of these individuals as full-status community members. In contrast, due to beliefs implying moral contamination, those labeled mentally ill are threatened with both subtle and outright social exclusion. We discuss implications of this idiom for EE and the detection of schizophrenia “prodrome” in China.
PMCID: PMC2894603  PMID: 19193742
discrimination; psychosis; idiom; prodrome; expressed emotion; families; Chinese
5.  The Work of Recovery on Two Assertive Community Treatment Teams 
The compatibility of recovery work with the Assertive Community Treatment (ACT) model has been debated; and little is known about how to best measure the work of recovery. Two ACT teams with high and low recovery orientation were identified by expert consensus and compared on a number of dimensions. Using an interpretive, qualitative approach to analyze interview and observation data, teams differed in the extent to which the environment, team structure, staff attitudes, and processes of working with consumers supported principles of recovery orientation. We present a model of recovery work and discuss implications for research and practice.
PMCID: PMC3104678  PMID: 20839045
Assertive Community Treatment; recovery; measurement; grounded theory
6.  On ‘False, Collusive Objectification’: Becoming Attuned to Self-Censorship, Performance and Interviewer Biases in Qualitative Interviewing 
In this paper, we discuss a problem in qualitative interviewing labeled by Bourdieu as ‘false, collusive objectification’. As described by Bourdieu, interviews where this occurs appear authentic because they often echo social science concepts and terminology and therefore may please the interviewer; however, they are actually unusable. We evaluate Bourdieu’s claim for the existence of ‘false’ interviews in light of the predominant postmodern position in qualitative research, offer examples from our own research on people diagnosed with mental illness and raise the issue of whether, when and how qualitative researchers should concern themselves with the shortcomings of interviews. We conclude with suggestions derived from Bourdieu’s view on how to address the problem he described.
PMCID: PMC2995459  PMID: 21132071
7.  A Theory of Social Integration as Quality of Life 
Quality of life, once a priority in caring for people with severe mental illness, has since been eclipsed by other concerns. This article returns attention to quality of life by offering a theory of social integration (as quality of life) for persons disabled by severe mental illness.
Data collection for this qualitative study consisted of 78 individual, unstructured interviews with 56 adults who have been psychiatrically disabled and field observations and interviews with staff and users that were made during eight ethnographic visits to service sites working to promote social integration. Data were analyzed with an inductive strategy based on grounded theory methodology and framed theoretically by the capabilities approach to human development. Goals were to identify personal capacities needed for integration, characterize occasions for capacity development in mental health care, and develop a working theory.
Six personal capacities were identified: responsibility, accountability, imagination, empathy, judgment, and advocacy. Occasions were characterized in terms of their defining mechanisms: contradiction, reinterpretation, rehearsal, raising expectations, and confrontation. A working theory was constructed to characterize the process of capacity development for social integration through exposure to increasingly challenging occasions for growth in the context of mental health care.
Capacities for social integration can be effectively developed as part of the everyday routines of mental health care. Eventually, the process shifts from development to the exercise of capacities and to participation as full citizens in the social world beyond treatment.
PMCID: PMC2784672  PMID: 18182536
8.  Rethinking Social Recovery in Schizophrenia: What A Capabilities Approach Might Offer 
Social science & medicine (1982)  2007;65(5):868-879.
Resurgent hopes for recovery from schizophrenia in the late 1980s had less to do with fresh empirical evidence than with focused political agitation. Recovery's promise was transformative: reworking traditional power relationships, conferring distinctive expertise on service users, rewriting the mandate of public mental health systems. Its institutional imprint is considerably weaker. This article takes sympathetic measure of that outcome and provides an alternative framework for what recovery might mean, one drawn from disability studies and Sen's capabilities approach. By re-enfranchising agency, redressing material and symbolic disadvantage, raising the bar on fundamental entitlements and claiming institutional support for complex competencies, a capabilities approach could convert flaccid doctrine into useful guidelines and tools for public mental health.
PMCID: PMC2018655  PMID: 17499900
recovery; schizophrenia; capabilities; disability; public mental health; USA

Results 1-8 (8)